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    Old 10-13-2011, 10:00 AM   #1
    avsevenx
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    L5-S1 Fusion through my stomach area

    I am new to this sight and this is my first post so I hope it makes sense. I was injured at work lifting and bending heavy equipment this was on December 2010, I went to the ER and they said I needed an MRI and sent me home with some meds for a few days. My left leg and back were hurting terribly and I couldnt get pain medication because I have not found a doctor yet. Then I went to Cary Orthopaedic and he sent me for an MRI and he was able to give me some pain meds. I went for the MRI and a few days later found out I had a L5-S1 disk herniation. Then my boss ended up filing this under workmans compensation because he said that since it happend at work this is how we needed to handle it. Then I had to go through the whole process over, went to a urgent care, got sent to Triangle Ortho. This is now February and I have been assigned to Dr. Dimmig and he does all the x-rays and looks at my MRI disk that I brought. He said to try the injection and pysical therapy first. I did the injection and had a not so pleasant reaction, my lower left side from my stomach to my ankle were completely numb for a day. Then I went to physical therapy and it didnt help because I was in too much pain. In the mean time the Dr. was giving me vicodin. After a couple weeks he decided that I needed a discectomy so he ordered that. Since it was workmans comp it took until April 25th to get the surgery. After I woke up I thought OH WOW I have been cured! Then about 4 hours later I found that I was way worse, my left side and my right side hurt worse than natural childbirth. I couldnt walk around at all well but I got sent home with dilaudid. I was in a wheelchair, I couldnt go to the bathroom without help, I couldnt do anything for myself. The doctor decided that he needed to go in and look around in my back and see whats happening. After I got that surgery on May 26 I was like I was before either surgeries. I still had leg and back pain. He added oxycontin to my medicine and down the line valium for the muscle spasms. I couldnt sleep so he gave me ambien. I stayed okay enough to walk or sit for 30-40 minutes at the time until mid August he cut my meds in half and I went downhill fast I couldnt deal with the pain I was in and went back to bedrest mainly. My doctor then decided to send me to Aquatic therapy, I went and hurt worse when I left than when I went in. I went to 8 sessions then quit because I just was to sick, I was at this point in September having issues with my bowels, bladder and vomiting. I went to my primary care dr. he said I had a bladder infection and gave me antibiotics and did bloodwork and sent me to a Neurologist. Now at current yesterday I went to my ortho dr. and he says that I need a fusion and that he want to go through my belly or front side as he said and do this procedure he said people only stay overnight and they are fine in a week. I find this very hard to beleive so I will ask anyone if they have any advice for this surgery. Please sent me a reply with any info you have. Thank you![QUOTE][/QUOTE]

     
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    Old 10-13-2011, 08:57 PM   #2
    teteri66
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    Re: L5-S1 Fusion through my stomach area

    Welcome to the board. I am very sorry to hear of all the problems you have had as a result of your injury and now your surgery.

    Did you call your spine surgeon to report the problems with your bladder and bowels? There is a situation called Cauda Equina Syndrome that is a very serious situation that can develop when there is damage to one or more of the lower lumbar spinal nerves. It can result in incontinence, or other issues, and you can read about it here, if interested:

    http://www.*****.com/a-to-z-guides/cauda-equina-syndrome

    It is important to have it diagnosed right away as it can result in permanent nerve damage.

    The last thing I would want to do is cause someone to lose confidence in his/her surgeon due to my comments...but your surgeon is not being straight with you regarding the ALIF...particularly seeing how much trouble you had with the simpler procedure. We have several people on the board who have just had a one level ALIF and I can assure you they were not "fine" at a week! At one week post-op, the steroids that are given prior to closing haven't even worn off yet...often at 10 days the patient is in worse pain than during the first week.

    Be sure to look through the older posts and read what others have gone through. It is MAJOR surgery and don't let this doctor convince you otherwise.

    There is lots of information pertaining to ALIF on ***** (the sister website of Healthboards) and other sites as well. But basically they go in from the front and have to move the major organs out of the way to access the front side of the spine. Often a spine surgeon works with a vascular surgeon who does this part of the surgery. Then the fusion is done, often using a cage, rods and pedicle screws. It is a major carpentry project involving sawing, drilling of bone, etc.

    It takes most patients a good 2 to 3 months to begin to feel somewhat normal again. Many go back to work at this point, but some are out 4 to 6 months, depending on the physical nature of their work. The new bone does not set up hard and strong for a year, so during that first 12 months the patient needs to be careful and watchful of his/her back.

    Are you allowed to get a second opinion or are you required to go to this particular surgeon?

    Last edited by teteri66; 10-13-2011 at 09:01 PM.

     
    Old 10-14-2011, 07:08 AM   #3
    cheryl1213
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    Re: L5-S1 Fusion through my stomach area

    hi --

    I am feeling really mixed after reading your post (side note: I'm not a formal writer here, but it would help if you had some paragraph spaces....just easier on the eyes, helps me read them...not sure if that's just me).

    I do appreciate that you have gone through a lot of more conservative treatments. I do NOT like when a doc or a patient jumps right to surgery (and, as you'll see in many of my posts, I'm a neurosurgeon's daughter...my doc is one of my Dad's partners...b/w the two of them, I know I get VERY honest and patient-oriented advice). You have put in a LOT of work and are still in pain which, to me, often means considering a bigger step.

    BUT, I am bothered by your doc's casual attitude towards the surgery. I had the same operation (known around here as an L5/S1 ALIF...the fusion through the belly) on 8/8. I am 33 and at a healthy size so I had/have the numbers on my side for the best of recoveries. My operation was a Monday, I was not sent home till Thursday...which is the norm for my doc. At one day, I'd only just gotten the catheter out and been allowed to try moving a bit with help.....the belly incision IS ultimately easier than the back one but it is REALLY hard the first few days to get to sitting or standing (the incision pain only lasted a couple weeks).

    The first week home (really 2nd post-op) was HARD. My BF was wonderful and accomodating but I needed him to do a LOT (he heard more than one panicked cry as I dropper a drink). They encourage walking and I'm a gym-rat but even I could only do a couple blocks that week. I hurt, a lot.

    I am unemployed, but my doc said he usually gives a 2 month estimate for a return to an office job after an ALIF, longer for active work. It is two months out now. I still am very much in recovery. I have better days and worse days (weather change this week hit me HARD), but I am NOT recovered. The docs told me to expect a 6m period till I really felt recovered....it is a year till the bone fully fuses so really a year of extra caution on what you do. Your entire spine needs to adjust to the changes from the ALIF so there are spasms up and down the whole back. I am also still on a LOT of meds...this may be partly b/c of me (I am very resistant to medicine and it takes a lot to help me...I have had the back issues for a couple years and pain from endometriosis for much longer).

    All that said -- I do think it was the right choice for me. The doc confirmed the disc was truly rotten (worst he'd seen in years and he does several of these a week...DO get a doc who does a LOT of them). The pain I have in recovery is def very different from the old pain which makes me confident it is from recovery and hopeful that I've been "fixed". I am in favor of ALIFs for the right patient, esp one who tried PT and shots etc, but do NOT expect the recovery your doc mentioned. It truly would make me consider another doc...it feels borderline unethical to make the promises he did. He might still be an excellent surgeon....again, as a doc's kid, I know a lot of neuros and can attest that many excellent surgeons aren't so skilled at patient interaction and can be clueless about the real day-to-day of recovery. But he is way off and I don't know why he'd make such statements.

     
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    Old 10-14-2011, 09:51 AM   #4
    teteri66
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    Re: L5-S1 Fusion through my stomach area

    Please consider the decision to have ALIF with this surgeon very carefully. I don't know if you have any choice in the matter, but if you do, I would strongly suggest you get at least another opinion before proceeding.

    The fact that you were told you had a bladder infection and no one looked into cauda equina syndrome makes me very uncomfortable. Please read up on CES so you are familiar with all the symptoms.

    [B]Anyone who has problems with the lower lumbar segments needs to know the symptoms for CES. It can happen at any time with sudden onset...and a patient needs to be prepared to seek medical help. Otherwise, the consequences of inaccurate diagnosis and treatment can be great.[/B]

     
    Old 05-18-2012, 03:39 PM   #5
    Ocean72
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    Re: L5-S1 Fusion through my stomach area

    Thank you so much for your story!! I hope you are feeling better by now! I just got mixed opinions from a very good and conservative surgeon. I saw him 10 years ago and told me to WAIT for as long as possible....Well, based in the 2008 MRI he suggested a fusion at L5-S1 (which 2 neuro suggested as well). Then, when he saw the new MRI, he thought a 3 level discectomy from L3-S1. The problem is that I already had TWO discectomy at L5-S1 and it herniated again!

    So will a 3rd discectomy help my L5-S1? I think I should just go ahead with the fusion on this disk and try the discectomy on L3 & 4. 4 was bulging but not herniated. Now I am thinking the L5-S1 is so weak that it caused the 2 disks above to go bad....

    Since I raised all these questions, now he wants me to go through those painful Discogram....I was in pain PRIOR to l4-L3 being herniated which tells me the L5-S1 was the problem then but the pain today is MUCH WORSE! My hips Burn....

    I am so confused. How are you feeling now?? Thank you again for your very informative post!

     
    Old 05-18-2012, 05:43 PM   #6
    teteri66
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    Re: L5-S1 Fusion through my stomach area

    What's happening at L4-L5?

    I tend to agree that it doesn't make much sense to do another discectomy at L5-S1 since it hasn't helped much the other two times.

    There is some research indicating that having a discogram "may" cause the discs to degenerate faster than they would otherwise...so if it can be avoided, it might be better.

    If you have specific questions, you might want to start a new thread. That way, more people will see it and hopefully respond.

     
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    Old 05-18-2012, 07:34 PM   #7
    Ocean72
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    Re: L5-S1 Fusion through my stomach area

    [QUOTE=teteri66;4982518]What's happening at L4-L5?

    I tend to agree that it doesn't make much sense to do another discectomy at L5-S1 since it hasn't helped much the other two times.

    There is some research indicating that having a discogram "may" cause the discs to degenerate faster than they would otherwise...so if it can be avoided, it might be better.

    Thanks!! The Doc saw something in the 08 MRI that led him to think the fusion would help me at the L5-S1 and possible L4 but wanted a new MRI. I went for my pre op appt. to sign off on the paperwork and when he looks at the new mri, he think a 3 level discectomy COULD take away my pain.

    The only thing I am wondering: Does it matter if the the 2 previous discectomy were done through microscopic needle? I am wondering if an "Open one" would make a difference??? Where they can really get access to the disk?? This Surgeon was going to do the open cut about 5" and do re exploration as well. ARGH!!!

     
    Old 05-18-2012, 08:01 PM   #8
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    Re: L5-S1 Fusion through my stomach area

    I personally think it can make a difference...but I'm not a doctor...and have no real knowledge if that is the case. But I would still be concerned that after two discectomies, doing a third might result in instability. It would be something to ask the surgeon.

    The problem is that every time there is surgery, there is the issue of scar tissue developing. It is preferable to limit the number of surgeries you have in any one area....Have you recently consulted with more than the one surgeon? It might be worthwhile doing so to see if there is any difference of opinion.

     
    Old 05-18-2012, 10:03 PM   #9
    Mina5612
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    Question Re: L5-S1 Fusion through my stomach area

    I am scheduled for fusion surgery (L4&L5;L5 & S1) on 7/18/2012. I have been in terrible pain for over eight years. I have been a runner all my life ( am now 55) and I'm sure all that pounding didn't help my back. I have tried cortisone injections,& physical therapy but now the nerve is compressed causing pain down my left leg and I have two herniated discs.

    Anyway the surgeon is going in from the back and now I'm a bit worried. Most of you say your surgeries were through the abdomen. Does anyone know why the surgeon would want to go in from the back?

    I also have two herniated discs in my neck causing excruciating pain. I was given Percocet for the pain but it only takes the "edge off". Should I ask for a stronger pain med-- don't want to become addicted to pain MEDS but am ALWAYS in pain.

    I'm pretty confused AND could use all the advice I can get! I'm really scared about the upcoming surgery. The nuero-spinal surgeon said full recovery will take up to a year. Does that mean no exercising for a whole year? I just don't know what to expect.

     
    Old 05-19-2012, 08:52 AM   #10
    Ocean72
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    Re: L5-S1 Fusion through my stomach area

    I feel for you! My life changed thanks to a car accident at age 31. I had a big herniation at C5-6 pressing on the nerve and the pain down my arms and entire body was awful. A GREAT Neuro Surg. from Boston did a Disk Implant in the cervical and guess what? I was driving 4 days later! That was in 2007 and my neck doesn't really bother me unless I over do it (like too much reading with my head down). Sadly, this Doc went back to boston. Richard Mendell or Mandell for anyone in Boston needing a good neuro.

    As for the back, I've two discectomy at l5-s1 and it is herniated, AGAIN! I've about 5 epidural injections. Last needle, the doctor said it was like a ROCK and had a hard time getting the needle trough.

    As for increasing your pain Meds: Don't do it now! WAIT until after your surgery! If you start now, the extra pain meds won't help you as much post op. BE SURE TO TELL YOUR DOCTOR THAT YOU NEED SOMETHING STRONGER FOR POST OP PAIN. My surgeon was going to give me percocet for post op (those things are like a baby aspirin). Percocet works fine for those who haven't used any pain meds before. But people like myself who have been using pain meds for 10 years, percocet does nothing for the pain. So yes, I'd ask for something stronger. They made still give you percocet but double the strengh which I think it is 600 instead of 325. BE SURE TO TAKE THEM AS INSTRUCTED! DON'T WAIT UNTIL THE PAIN KICKS IN OR YOU WILL BE SORRY! I tried on my last back surgery not to take them until I "needed" them and boy, when the pain comes knocking, it comes on so strong and fast, enought to make you scream. So take them as prescribed, even if you think "I don't need them" (at least the first few weeks post op). I wish you the best of Luck!!! Keep me posted. My should be late June (I hope to get in ASAP).

    Last edited by Ocean72; 05-19-2012 at 08:56 AM.

     
    Old 05-19-2012, 09:52 AM   #11
    teteri66
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    Re: L5-S1 Fusion through my stomach area

    Welcome to the board. Don't fret over your surgeon's decision to go in from the back. There are various ways of approaching the spine and it all depends on the patient's individual body type and what are the issues. I have had three lumbar surgeries, all from the back.

    Have you had more than one opinion regarding the need for surgery and what type of surgery? It is always a good idea to get several opinions, as fusion is a big surgery, and the last resort as far as surgery goes.

    If you are comfortable that fusion is the right solution then you should be prepared for a lengthy recovery. The year time frame you were given is the time it typically takes for the bone graft to set up so it is hard and fully fused.

    They will have you up walking within about 12 hours after surgery...and you will continue walking as the most important part of rehab and recovery. Depending on your surgeon's instructions, you will begin physical therapy where you will be given appropriate exercises to strengthen muscles and will be taught appropriate ways to use your back so as not to put more strain on the damaged area.

    Around three months you will gradually return to more normal activities, again depending on your surgeon's evaluation of your progress.

    If you decide to return to running, I would imagine you would want to wait until you are solidly fused. The pounding would make fusion impossible until the cells have completed their "knitting together."

    Many of us make some changes in previous lifestyle after a successful fusion. The thinking is having been through fusion once, why do an elective activity that I know puts additional stress on my spine? I would rather preserve what I have for as long as possible...but others feel that life wouldn't be worth living if they couldn't engage in the more punishing physical activities, and opt to continue on doing whatever they want. That is an individual choice that is made after the successful completion of a fusion.

    I can't help you with cervical issues, but wanted to make you aware that there is a separate board called "Spinal Cord Disorders" where people with cervical issues hang out. You might want to post there, too.

     
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